Please Complete: Health Form

Adult Health Form

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Page 1


Asthma/Respiratory Problems

VISIONS requires anyone with asthma or respiratory issues to bring with them the medications and associated devices (i.e.: inhaler, nebulizer, spacer, etc.) for all status levels, including: daily (green), caution (yellow), and emergency (red). We recommend bringing multiple emergency inhalers, depending on the severity of the case.


Physical Restrictions

Contacts and Insurance

First Emergency Contact

Second Emergency Contact

Medical Providers
(This section is optional)

Health Insurance
(This section is optional)